超声引导下粘连松解术联合富血小板血浆在肩袖损伤治疗中的应用

Application of ultrasound-guided adhesiolysis combined with platelet-rich plasma in the treatment of rotator cuff injuries

目的探究肩袖损伤应用超声引导下粘连松解术联合富血小板血浆治疗的疗效。方法对2017年12月至2019年12月在陆军第七十二集团军医院治疗的肩袖损伤患者103例临床资料进行回顾性分析,依据患者治疗方式分为两组,对照组(n=48)接受超声引导下粘连松解术治疗,研究组(n=55)在对照组基础上加用富血小板血浆肩关节腔内注射治疗。比较两组患者治疗疗效,治疗前后疼痛评分、肩关节功能评分、肩关节活动范围,愈合率以及再撕裂发生率。结果研究组患者治疗总有效率高于对照组(96.36%比81.25%,χ^(2)=6.14,P<0.05);两组患者治疗后疼痛评分[研究组:(1.69±0.81)分比(6.13±1.28)分;对照组:(3.22±1.05)分比(6.13±1.28)分;t=31.510、8.33,均P<0.001]、改良加州大学洛杉矶分校肩关节(UCLA)评分[研究组:(33.26±3.81)分比(14.03±2.96)分;对照组:(28.81±3.20)分比(13.92±3.03)分;t=42.13、33.12,均P<0.001]、Constant-Murley肩关节功能评分量表(CMS)评分[研究组:(94.22±4.15)分比(55.29±8.18)分;对照组:(82.11±8.13)分比(56.33±7.83)分;t=46.83、22.38,均P<0.001]等肩关节功能评分较治疗前显著改善,治疗后研究组患者疼痛评分低于对照组,UCLA评分、CMS等肩关节功能评分显著高于对照组[(1.69±0.81)分比(3.22±1.05)分,(33.26±3.81)分比(28.81±3.20)分,(94.22±4.15)分比(82.11±8.13)分;t=8.33、6.37、9.70,均P<0.001];两组患者治疗后前屈[研究组:(159.26±13.51)°比(85.26±11.35)°;对照组:(150.22±14.35)°比(86.33±11.51)°;t=45.15、34.23,均P<0.001]、外展90°内旋[研究组:(83.64±5.29)°比(60.33±4.12)°;对照组:(76.81±4.82)°比(60.61±4.51)°;t=36.74、24.06,均P<0.001]、外展[研究组:(161.29±10.76)°比(72.91±5.16)°;对照组:(152.81±11.84)°比(73.26±5.22)°;t=82.34、64.61,均P<0.001]、外展90°外旋[研究组:(87.82±3.04)°比(4.29±5.18)°;对照组:(80.22±4.13)°比(80.22±4.13)°;t=42.46、21.55,均P<0.001]以及中立位外旋角度[研究组:(43.18±3.20)°比(22.85±4.12)°;对照组:(37.26±4.12)°比(22.64±3.95)°;t=41.19、25.10,均P<0.001]均明显增加;研究组患者治疗后上述肩关节活动范围均显著高于对照组[(159.26±13.51)°比(150.22±14.35)°,(83.64±5.29)°比(76.81±4.82)°,(161.29±10.76)°比(152.81±11.84)°,(87.82±3.04)°比(80.22±4.13)°,(43.18±3.20)°比(37.26±4.12)°,t=3.29、6.81、3.81、10.72、8.20,均P<0.001];两组患者愈合率差异无统计学意义(70.91%比66.67%,χ^(2)=0.21,P>0.05),研究组再撕裂率显著低于对照组(1.82%比16.67%,χ^(2)=5.35,P<0.05)。结论肩袖损伤应用超声引导下粘连松解术联合富血小板血浆治疗可以显著改善患者肩关节功能、疼痛程度以及肩关节活动范围,治疗疗效优异。

Objective To investigate the efficacy of ultrasound-guided adhesiolysis combined with platelet-rich plasma in the treatment of rotator cuff injuries.Methods The clinical data of 103 patients with rotator cuff injuries treated in The 72nd Military Hospital of PLA from December 2017 to December 2019 were retrospectively analyzed.The patients were divided into two groups according to the treatment methods.The control group(n=48)was treated with ultrasound-guided adhesiolysis.The study group(n=55)was treated with ultrasound-guided adhesiolysis and intra-articular injection of platelet rich plasma.Therapeutic effects,pain score,shoulder function score,shoulder range of motion,healing rate,and re-tear rate were compared between the control and study groups.Results Total effective rate was significantly higher in the study group than in the control group(96.36%vs.81.25%,χ^(2)=6.14,P<0.05).Pain score in each group was significantly decreased after treatment compared with before treatment[study group:(1.69±0.81)points vs.(6.13±1.28)points;control group:(3.22±1.05)points vs.(6.13±1.28)points,t=31.510,8.33,both P<0.001].The University of California at Los Angeles(UCLA)shoulder score in each group was significantly increased after treatment compared with before treatment[study group:(33.26±3.81)points vs.(14.03±2.96)points;control group:(28.81±3.20)points vs.(13.92±3.03)points,t=42.13,33.12,both P<0.001].Constant-Murley Score in each group was significantly increased after treatment compared with before treatment[study group:(94.22±4.15)points vs.(55.29±8.18)points;control group:(82.11±8.13)points vs.(56.33±7.83)points;t=46.83,22.38,both P<0.001].After treatment,pain score was significantly lower in the study group than in the control group[(1.69±0.81)points vs.(3.22±1.05)points,t=8.33,P<0.001].UCLA score and CMS were significantly higher in the study group than in the control group[(33.26±3.81)points vs.(28.81±3.20)points,(94.22±4.15)points vs.(82.11±8.13)points,t=6.37,9.70,both P<0.001].After treatment,there were improvements in flexion[study group:(159.26±13.51)°vs.(85.26±11.35)°;control group:(150.22±14.35)°vs.(86.33±11.51)°;t=45.15,34.23,both P<0.001],internal rotation at 90°abduction[study group:(83.64±5.29)°vs.(60.33±4.12)°;control group:(76.81±4.82)°vs.(60.61±4.51)°;t=36.74,24.06,both P<0.001],abduction[study group:(161.29±10.76)°vs.(72.91±5.16)°;control group:(152.81±11.84)°vs.(73.26±5.22)°;t=82.34,64.61,both P<0.001],external rotation at 90°abduction[study group:(87.82±3.04)°vs.(4.29±5.18)°;control group:(80.22±4.13)°vs.(80.22±4.13)°;t=42.46,21.55,both P<0.001],and external rotation in neutral position[study group:(43.18±3.20)°vs.(22.85±4.12)°;control group:(37.26±4.12)°vs.(22.64±3.95)°;t=41.19,25.10,both P<0.001]in each group compared with before treatment.After treatment,range of motion of the shoulder in the above positions was significantly higher in the study group than in the control group[flexion:(159.26±13.51)°vs.(150.22±14.35)°;internal rotation at 90°abduction:(83.64±5.29)°vs.(76.81±4.82)°;abduction:(161.29±10.76)°vs.(152.81±11.84)°;external rotation at 90°abduction:(87.82±3.04)°vs.(80.22±4.13)°;external rotation in neutral position:(43.18±3.20)°vs.(37.26±4.12)°,t=3.29,6.81,3.81,10.72,8.20,all P<0.001].There was no significant difference in healing rate between the study and control groups(1.82%vs.16.67%,χ^(2)=5.35,P<0.05).Conclusion Ultrasound-guided adhesiolysis combined with platelet-rich plasma is highly effective in the treatment of rotator cuff injuries because it can greatly improve shoulder function,reduce pain degree,and increase the range of motion of the shoulder.